Transcript Who are we and what do we do? Research active Staff

6th National Children & Young
People Survivorship Workshop
A GP perspective
Una Macleod
Professor of Primary Care Medicine
Primary care cancer lead, HYCCN
Hull York Medical School
[email protected]
1
Role of GPs
 What can you expect from GPs?
 What do GPs want from you?
2
Context
 GPs will see children and young people with cancer
rarely in their working lives
 A practice is very unlikely to have more than one
child/young person with cancer at any given time
 GPs are generalist, family doctors
3
GPs and cancer patient reviews
 The development and testing of a tool to
structure cancer care reviews in general practice
 Funded by Macmillan Cancer Support
 Work done in Glasgow
 Research team: Una Macleod, Liz Mitchell, Susan
Browne, David Linden, Pat Quinn
4
Background
 GMS Contract, QOF and cancer care reviews
 655 clinical points, 11 cancer points
 Cancer register
 Cancer care reviews
 cancer review “to cover the patient’s individual health
support needs” and “the co-ordination of care
between sectors.”
5
Issues
 What is the role of primary care in the
management and follow up of patients with cancer?
 supportive and coordinating
 follow up, detection of recurrence, assessment
 management of physical and psychological co-
morbidities
 Need to produce evidence
 to inform the quality care agenda and
 produce quality measures to assess performance
6
Aim
To develop and test the feasibility of
conducting a structured cancer care
review in primary care
7
Research Questions
1. What models of cancer care review, relevant to patients,
primary care and the NHS, can be identified and
supported by research evidence?
2. What do patients, primary care professionals and primary
care cancer care opinion leaders believe are the essential
elements of a cancer care review?
3. How do practices currently carry out cancer care reviews?
4. How do newly diagnosed cancer patients currently view
the input received from primary care?
5. Is the structured care review feasible in practice and what
barriers would there be to its implementation?
8
Overview of methods
 STRAND 1: Identify the essential elements of a
cancer care review
 STRAND 2: Development and construction of
the cancer care review tool
 STRAND 3: Feasibility study
9
STRAND 1: Essential elements of a cancer
care review
A. Literature review of primary care input following
B.
C.
D.
E.
cancer diagnosis
Secondary analysis of interviews with patients
with colorectal cancer
Interviews with primary care professionals
Focus groups with lay representatives of people
affected by cancer
Questionnaire survey of general practices on
existing cancer care reviews
10
STRAND 1: Essential elements of a cancer
care review
A. Literature review of primary care input following
B.
C.
D.
E.
cancer diagnosis
Secondary analysis of interviews with patients
with colorectal cancer
Interviews with primary care professionals
Focus groups with lay representatives of people
affected by cancer
Questionnaire survey of general practices on
existing cancer care reviews
11
Questionnaire to practices
12
Participating practices
 110 Qs returned – 89 GG&C / 21 A&A
 Overall response rate – 32.7%
 575,000 patients represented
 11% Scottish population
 Average list 5,693 (1,223 – 13,162)
 31.7% with more than half of patients living in top
15% most deprived areas
13
Workload
 Average of 21 patients per practice diagnosed in
previous 12-months
 Median: 17
 Range: 1 – 100
 Majority of patients had cancer care review (as per
QOF framework)
 >75% in 82% of practices
 Mean: 92%
 Range: 1 – 100%
14
Timing
of
review
When does cancer care review in your practice typically take place?
REVIEW TIMING
PRACTICES (%)
Within 1 month of diagnosis
58 (52.7)
Within 6 months of diagnosis
48 (43.6)
6-12 months after diagnosis
2 (1.8)
Other
2 (1.8)
2 practices did not respond to the question
15
Frequency
of
review
How often are reviews undertaken for cancer patients in your practice?
REVIEW FREQUENCY
PRACTICES (%)
Once only
27 (24.5)
Once a year
9 (8.2)
Twice a year
12 (10.9)
3-4 times a year
9 (8.2)
As required
31 (28.2)
Monthly (esp. palliative patients)
12 (10.9)
Other
8 (7.3)
2 practices did not respond to the question
16
Frequency
of
review
What initiates a cancer care review for a patient?
PRACTICE (%)
ONLY
METHOD
71 (64.5)
50 (45.6)
Request by patient
7 (6.4)
—
Request by other person
1 (0.9)
1 (0.9)
45 (40.9)
25 (22.3)
All methods used
2 (1.8)
—
Other
8 (7.3)
5 (4.5)
INITIATION METHOD
Practice protocol / reminder
Conducted opportunistically
3 practices did not respond to the question
17
Responsibility
for
review
Who typically has responsibility for completing cancer care reviews?
INITIATION METHOD
PRACTICE (%)
ONLY PERSON
102 (92.7)
90 (81.8)
Practice nurse
4 (3.6)
2 (1.8)
District nurse
12 (10.9)
2 (1.8)
All practitioners involved
2 (1.8)
—
Other
2 (1.8)
2 (1.8)
GP
18
Format
of
review
What is the most common method of completing cancer care review?
INITIATION METHOD
PRACTICE (%)
ONLY
METHOD
Face-to-face consultation
93 (84.5)
80 (72.2)
5 (4.5)
—
22 (20.0)
13 (11.8)
5 (4.5)
3 (2.7)
Telephone consultation
Review of medical record
Other
1 practice did not respond to the question
19
Content of existing cancer
care review: 1
100
90
80
% PRACTICES
70
60
Physical symptoms
Psych wellbeing
50
Medication
40
30
20
10
0
Always
Sometimes
Rarely/never
20
Content of existing cancer
care review: 2
100
90
80
% PRACTICES
70
60
Treatment plan
Treatment side effects
50
Complications of treatment
40
30
20
10
0
Always
Sometimes
Rarely/never
21
Content of existing cancer
care review: 3
100
90
80
% PRACTICES
70
Information needs
60
Communication with secondary
care
50
Financial issues
40
Carer issues
30
20
10
0
Always
Sometimes
Rarely/never
22
“... most important element of a
review”
 Many varied comments, but most fell into the
following categories:
 Communication:





doctor/patient relationship issues
exploring ideas, concerns and expectations
about cancer diagnosis
with other team members
with secondary care
“How can I help you?”
“Personal contact”
 Addressing unmet needs:



symptom assessment and control
how they are being affected by the illness
psychological issues, fears for the future, emotional issues
23
Professional interviews
24
What GPs said - I
 The current cancer care review carried out as part of
QOF could be improved on relative to other conditions.
 Apprehension over the nature of any proposed change
and the possible impact on existing workload and the
doctor-patient relationship.
 Reluctance for formal measures within assessment
 Patient centred assessment key
25
What GPs said - II
 Key aspects of a review were: considered to be:
o patients’ understanding and experience
o patients’ wishes and expectations
o psychological and emotional assessment
o assessment of symptoms
o medication review.
26
The Glasgow Cancer Care Review Template
 Assessment of physical need
 Medication review
 Assessment of psychological need
 Signposting of relevant services
27
What GPs want from you
 Information
 Timely
 Appropriate
 Guidance
 Awareness of GP role
 Generalist
 Family doctor
28
The world is changing: what will
it mean..?
29